Under 18 Waiver

Assumption of Risk Form

Children under 18 years of age

Parent / Guardian Contact Information

Name*

FirstLast

Address*

Street AddressAddress Line 2CityStateZIP Code

Home Phone*

Email*

Emergency Contact Information

Phone*

Email*

Consent with Respect to Minors

As the legal guardian of this child, I agree that neither Elite Fitness, nor the staff, officers, trustees, agents or instructors of either organization may be held liable in any way for any injury, death or other damage to them or their property arising out of or resulting from their participation in activities at or sponsored by Elite Fitness.

Permission is hereby given for any emergency anesthesia, operation, hospitalization or other treatment which might become
necessary as a result of my children's participation.

Name of participant under the age of 18

Date of Birth

MM

DD

YYYY

Name of participant under the age of 18

Date of Birth

MM

DD

YYYY

Name of participant under the age of 18

Date of Birth

MM

DD

YYYY

This consent must be completed, signed, and dated by a parent or legal guardian.

Signature*

Please use your mouse, trackpad, or finger to sign your name.

Relationship to above participants*

Parent

Legal Guardian

Print Name*

Date*

MM

DD

YYYY

Waiver of Liability

Member Name(s)*

Please separate names by commas

Home Address*

Street AddressAddress Line 2CityStateZIP Code

Home Phone

Work Phone

Cell Phone

Email

Emergency Contact*

Emergency Phone*

I understand the risk of injury from CLUB activities and using any CLUB equipment is significant, including the potential for permanent paralysis and death, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown. I acknowledge that this is an UNSUPERVISED FITNESS CENTER and I assume all risks associated with using exercise equipment and other products and machines and exercising alone without the aid and presence of CLUB staff on the premises. In addition, I acknowledge that club activities may include outdoor activities which may present additional risks, such as slippery surfaces, uneven surfaces, loose rock or gravel, and unseen roots and other items. I understand that Elite Sport and Fitness Arizona LLC is independently owned and operated . I HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Elite Sport and Fitness Arizona, LLC and its affiliates, INCLUDING THE OWNERS OF ALL CLUBS, as well as all sponsors and advertisers, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, LOSS OR DAMAGE to person or property that may arise out of or in connection with my use of any of the equipment products and machines or the facilities of the CLUB, or any indoor or outdoor exercise program offered at or by the CLUB, or any incident that is otherwise related to my membership. I expressly agree that this release is intended to be as broad and inclusive as permitted by applicable law and if a portion of this release is held invalid, the balance shall remain in full force and effect. This release shall to my heirs, assigns, personal representatives and any other next of kin . I hereby acknowledge that this facility is under 24-hour recorded video surveillance, which may be retained by the CLUB for subsequent review.

2. Any other reasons that would limit you from participating in a fitness program? If yes, please explain:*

3. Have you undergone any surgeries or have been hospitalized in the past 12 months, If yes, please explain:*

4. Have you received physical/chiropractic care? If yes, explain:*

5. How many meals do you eat in a day?*

6. When was the last time you participated in a regular exercise program.

Currently

Never

Within the last 6 months

Within in the last 2 years

7. How do you spend most of your time at work? (Check all that apply)*

Sitting

Standing

Carrying loads

Walking

8. Please check all goals that apply to you:*

Lose Weight and/or Inches

Gain Weight and/or Inches

Increase Strength

Firm and Tone Muscle

Build Endurance

Improve Athletic Performance

Reduce Stress

Other(s)

Other Goals*

9. In your own words, tell us about your SHORT TERM fitness goals.*

10. In your own words, tell us about your LONG TERM fitness goals.*

11. On a 1-10 scale, how serious are you about making a change to your lifestyle?*

Please enter a value between 1 and 10.

12. Areas of injuries/concern?

Knees

Shoulders

Upper / Lower Back

Neck

Elbows

Other(s)

Other Areas of Injuries / Concern*

13. Fitness Professional Preference*

Male

Female

No Preference

14. Time(s) Available

Morning

Afternoon

Evening

Other Time(s)*

I realize that improper use of equipment or imprudent exercise beyond my capabilities can result in injury or risk of injury. I agree that I am exercising at my own risk and do not hold my trainer or Elite Fitness responsible for any injuries.